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Pilot Program Brings Hospital Care into the Home

Hospital care today is estimated to cost $1 trillion annually, accounting for almost one-third of the health care spending in the United States. A new pilot program, “The Home Hospital”, has looked into reducing these costs while at the same time maintaining the quality of care by providing patients with treatment at home instead of in the hospital. This program not only aims to address skyrocketing hospital care but also responds to the growing desire by individuals for home health care.

Boston’s Brigham and Women’s Hospital (BWH) and Brigham and Women’s Faulkner Hospital (BWFH) were behind the innovative program in which patients are sent home for treatment following an emergency room visit. Patients receive the same level of care in the comfort of their homes as they would if they were in the hospital.

“By moving people to their home we automatically are able to customize what they need and tailor it to them and that’s part of the place where we see a lot of cost savings,” said Dr. David Levine, a physician and researcher at the Division of General Internal Medicine and Primary Care, and co-principal investigator Jeff Schnipper, MD, MPH, of the project at BWH and BWFH.

Dr. Levine also believes that patients at home recuperate better than when in the hospital, as they are more ambulatory at home. Home patients walk 10 times more than those in the hospital. “We believe that because patients are moving more at home that they’re going to be able to preserve their strength and end up better off afterward,” said Dr. Levine.

Twenty-one adult patients participated in the randomized, controlled trial, according to an article published in the BWH Clinical & Research News. The patients were required to live within five miles of the Brigham in order to participate, came to BWH or BWFH Emergency Department (ED) seeking care for problems including infections, heart failure, asthma exacerbation, and chronic obstructive pulmonary disease (COPD). The ED determined that they required admission, but before being admitted, eligible patients could enroll and be randomly selected for either the home hospital or traditional hospital admission.

Home patients received daily visits from a physician and nurse, had 24-hour access to a medical team via phone, text, and video with the use of a tablet, and had their vitals remotely monitored by a skin patch. Patient activity and sleep were also monitored, cited the BWH article, in order for the team to test its hypothesis that patients move and sleep more when they are at home.

Prior to patient selection for the pilot program, a safety check was performed at each home, along with medication reconciliation checks to ensure the patients were comfortable with using the tablet. The pilot used the same clinical criteria for discharging that BWH uses for inpatients, including checking a patient’s clinical stability, ability to eat and drink, and pain control.

“For over a decade, the home hospital model has been practiced in Europe and Australia, where patients have experienced the same level of safety and quality compared to traditional hospital stays, in addition to improved patient experience and reduced costs,” Dr. Levine said. “But this model has rarely been tried or rigorously tested in the U.S. We believe receiving care at home puts the patient first, improves patient experience and reduces costs. Patients can sleep in their own bed, eat their own food, and spend more time with family and friends. For many conditions, a home hospital will transform our concept of safe, high-quality and cost-effective care.”

Dr. Levine plans to re-launch the project this spring, accepting a broader range of patients with different conditions. Home health care is typically less expensive, more convenient, and just as effective as the care provided in a hospital or skilled nursing facility. Pilot programs such as the one at BWH further underscore the support and growth of the home health care industry.